CMS Proposes New Rule Targeting Fiscal Integrity of Medicaid

In September, the owner and operator of an Atlanta-based in-home care provider pleaded guilty to defrauding Medicaid in a $1.2 million scheme. Shortly before that, a Boston-based in-home provider agreed to pay $1.95 million in a settlement to resolve allegations that it submitted Medicaid claims without physician authorization in August. These cases are both part […]

CMS Wants to Use Artifical Intelligence to Sniff Out Home Health Fraud

Federal watchdogs and health care policymakers are signaling plans to ramp up oversight of fraud, waste and abuse in 2020, especially when it comes to home health and hospice agencies. While the efforts are, in part, linked to the misuse of Medicare dollars by bad actors, they’re also simply a result of the U.S. health […]

Texas Physician Found Guilty of $16M Home Health Scheme; Pennsylvania Provider Accused of ‘Sham Staffing’

A Texas-based physician has been found guilty for taking part in a $16 million Medicare scheme. On Oct. 7, the U.S. Department of Justice (DOJ) announced that, after a six-day trial, Dr. Yolanda Hamilton was convicted of a single count of conspiracy to commit health care fraud and conspiracy to solicit and receive health care […]

What ‘Significant’ AseraCare Ruling Means for Home Health Providers

A recent hospice-related court ruling may impact how federal watchdogs and whistleblowers go after home health agencies moving forward. Last month, the U.S. Court of Appeals for the Eleventh Circuit issued its long-anticipated decision in United States vs. AseraCare, a winding legal battle involving false claims allegations dating back to 2008. Hospice companies, other Medicare-reimbursed […]

New York Home Care Agency Allegedly Threatened Workers with Deportation

A New York-based home care agency is being placed under the microscope for its treatment of immigrant workers. Allcare Homecare Agency Inc. allegedly threatened to report immigrant workers to Immigration and Customs Enforcement (ICE) agents when they complained about unpaid wages, according to a Friday statement from the New York State Attorney General’s Office.  As […]

Bay Area Home Health Provider Charged in $115M Medicare Scheme; Medicaid Fraud Defendants Plead Guilty

Home Health Provider Charged in Largest Ever Cash-for-Patient Scheme in NorCal The Bay Area’s largest home health care provider has been charged by federal prosecutors with paying doctors in a Medicare kickback scheme involving millions of dollars of payments in cash, Warriors tickets, designer handbags and more. Amity Home Health Care paid kickbacks to doctors, […]

[Updated] Guardian Healthcare Resolves Improper Billing Allegations; Home Health Recruiter Found Guilty in Medicaid Kickback Scheme

Guardian Healthcare resolves allegations Boston-based Guardian Healthcare has entered into a financial settlement with MassHealth, the Massachusetts Medicaid program, according to Law360.  The home-based care provider — which offers home health and home care services — agreed to pay $1.95 million to resolve allegations that it submitted Medicaid claims without physician authorization that the services were […]

OIG Calls for Additional Oversight of Home Health, Personal Care Service Providers

In a new report released Monday, the U.S. Department of Health and Human Services Office of Inspector General (OIG) highlighted dozens of its unimplemented recommendations for reducing fraud, waste and abuse throughout the Medicare and Medicaid systems. Many of the recommendations were tied to home health, hospice and personal care services, in addition to how […]

Home Health Company Forced to Pay Back Wages to 233 Employees

As restitution for violating state wage laws, a Massachusetts home health care company and its owner have been ordered to pay $162,000 in penalties and back wages to more than 230 employees. Massachusetts Attorney General Maura Healey announced Monday that Worcester-based Pinnacle Home Healthcare Services Inc. and owner Pauline Mwangi failed to pay caregivers their […]

House Lawmakers Looking to Relax Anti-Kickback Rules in Value-Based Care Arrangements

A bipartisan group of U.S. lawmakers is looking to relax federal anti-kickback rules related to how, when and where physicians refer their patients. Doing so could mean smoother referral relationships for home health providers, especially the biggest ones and those operating within an accountable care organization (ACO). Efforts to loosen anti-kickback regulations come from the […]